Introduction
Nursing is an essential profession, making up one of the largest occupations worldwide. As a crucial profession, the demand for nurses has been high throughout history, encouraging its growth as more individuals embraced education in nursing. However, the sector has faced significant challenges in recent years due to nurse shortages.
The nursing workforce has declined for various reasons, which has prompted medical and public health professionals to raise concerns. The primary reasons include an increased population of seniors, a lack of nurse educators, the impact of healthcare reforms, and occupational burnout. The shortage has impacted various sectors of patient healthcare, such as under- or overmedicating patients, lapses in treatment continuity, and medical errors due to fatigue and workplace stress.
Patients must wait longer to receive healthcare services that are performed quickly due to poor staffing, leading to poor service delivery. The healthcare system must acknowledge the challenge as an urgent crisis and find quick and effective solutions. This essay explores the causes of nurse shortages in the United States, including the increased senior population, lack of nursing educators, health policy reforms, and occupational burnout.
Definition of Nursing Shortage
In recent years, the staggering demand for nurses has reached a critical point that needs immediate addressing. A nursing shortage refers to an inadequate nursing professionals for more prolonged periods, affecting numerous health facilities nationally and leading to severe consequences for patients. According to statistics, the nursing shortage is projected to increase in the coming years if the situation is not addressed sooner (Rosseter, 2020). The United States has experienced nurse shortages periodically throughout history due to various factors that have not been addressed. Thus, it is necessary to explore the cause, which may help health practitioners and scholars find effective mitigation measures and restoration of quality services to the public.
Increased Population of Seniors
One of the causes of nurse shortages is the increased number of senior citizens in the nation. The most prominent citizen population in the United States is the aging generation, consisting of baby boomers. The aged population continues to grow, and people are predicted to reach more than 70 years old by 2030 (Tamata & Mohammadnezhad, 2022). The increased number of senior citizens has strained medical facilities due to a higher demand for care services. With medical advances in the modern era, people can live longer than 70 years and require constant care to live healthy lives.
At the same time, the aged population is prone to numerous chronic ailments that require medical attention. According to Tamata and Mohammadnezhad (2022), five out of eight of America’s seniors have more than one chronic ailment. The chronic ailments include depression, lung disease, stress, diabetes, and Alzheimer’s, which need constant and quality care to ensure the patient’s well-being. The number is expected to increase as the population grows, which will demand more nurses, leading to a pronounced nursing shortage.
Hence, the healthcare system needs more nurses to cater to the people, creating a shortage in demand and supply. Health facilities are already experiencing nursing shortages due to other factors, such as the increase in the outpatient population due to the increase in the general population. Thus, a higher demand to care for older adults will strain the profession, resulting in nursing shortages in the region.
Consequently, the increased number of senior citizens has affected the size of the nursing workforce. Most of the aged population comprises the existing workforce in nursing and other sectors, resulting in a decrease in nurses due to retirement. The profession is being drained by senior nurses who have approached retirement age, leaving a considerable gap in staffing. The United States nursing population comprises baby boomers reaching 65 years, the appropriate age for nurse retirement, while the number of those enrolling in the profession is still staggering.
According to Haddad et al. (2018), the number of older nurses about to retire soon is increasing and could reach 71% by 2030. During the Coronavirus pandemic, more senior nurses were given early retirement as hospitals received fewer patients, leading to a decline in financial resources. Hence, many medical facilities were forced to reduce staff to sustain the hospitals, which caused the early retirement of older nurses.
The move significantly contributed to the nursing shortage when healthcare facilities resumed normal functioning. In addition, an estimated one million registered nurses will retire from the profession in the next five years, leading to more shortages (Daniel & Smith, 2018). Efforts to resolve the issue should be underway to avoid a more severe deficiency, which will significantly influence the health sector. Therefore, the coupled effect of the aging citizen population and nurses has contributed substantially to the nursing shortage, which continues to decline due to the lack of nurse educators in nursing colleges.
Lack of Nurse Educators
Another cause is inadequate nursing educators, which has directly affected the nation’s nursing shortage and the quality of nursing. Reduced enrollment in nursing schools and a lack of quality training are among the barriers contributing to nurse shortages in the United States. Challenges leading to decreased enrollment include inadequate faculty, budget constraints in nursing colleges, and insufficient space to hold students (Collard et al., 2020). Nursing schools have few faculty nationwide to cater to the rising demand for registered nurses (RN) to fill senior and retiring staff positions.
Although many individuals have applied to enroll in nursing schools, the shortage of nurse educators has limited enrollment, limiting student capacity. According to the American Association of Colleges of Nursing (AACN), nursing schools turned away over 91,000 qualified applicants in 2021 due to capacity constraints and inadequacies in nursing educators (Rosseter, 2020). The nursing school reported that the main reason for rejecting the applications is the lack of nursing educators to facilitate training. Nurse educators have become inadequate in schools due to numerous factors, including aging faculty, competition in the job market, lack of qualified professionals, and budget constraints to facilitate the recruitment of more staff. Like senior nurses, many nursing educators are baby boomers who have neared retirement age, leaving a significant occupation gap when they retire.
Competition in the job market has led many educators to join the private sector, as it offers luring compensation compared to the public sector. Nursing educators are among the most advertised occupations in public colleges, with a demand of approximately 2000 educators in graduate and baccalaureate programs (Collard et al., 2020). The vacant positions are due to shifts from public colleges as educators to practicing in private clinics, which offer better remuneration. Further, an additional 200 nurse educators are needed to accommodate the rising students enrolling in nursing schools to fill the enormous gap left by retirees and those leading the profession for various reasons.
Lastly, few professionals are qualified for nursing educators as the number of individuals enrolling for doctoral and master’s degrees is declining (Haddad et al., 2018). The decline is attributed to a lack of nursing educators in higher education, leading to reduced enrollments and affecting the enrollment of fresh graduates. Therefore, nursing educators play a vital role in producing quality nurses, and a lack of professionals significantly contributes to the nursing shortage in the nation.
Healthcare Policy Reforms
The nursing profession is highly connected to policy reforms in the public, financial, and health sectors. Recent developments in healthcare insurance reforms have affected nurse staffing in numerous health facilities, increasing the demand for nurses. The Affordable Care Act (ACA) is among the reforms that have contributed to nurse shortages in the United States. The act offers subsidies and fair insurance policies to ensure equality in healthcare. Although the move aims to benefit public health, it means a higher flow of patients in medical facilities.
Health centers will require additional registered nurses to match the rising patient demand. Studies by Marć et al. (2018) reveal that the implementation of the ACA will lead to a rise in demand for RNs up to 3.5 million nurses. Making healthcare affordable to all individuals has resulted in many patients in the outpatient sector, which requires more nurses for quality service delivery. Thus, the number of nurses needed in outpatient care and physician offices must rise to fill the supply and demand gap.
Besides affordable medication, health insurance policies have capitalized on the ACA reforms to create premium packages for home care and financially able individuals. The policy requires RNs to have additional education and specialization to provide quality services in home care and private settings. Hospitals that offer poor services and do not meet the demands of the insurance policy do not receive incentives, leading to disproportionate remuneration among nurses (Daniel & Smith, 2018).
Thus, many young RNs opt for additional education to acquire specialized skills, guaranteeing higher pay. The shift in nurses from the public and outpatient sectors to home care and private settings plays a major role in the nursing shortage as the remaining nurses strain to deliver in public health facilities. Therefore, the healthcare system must review its nursing and insurance policies to curb the nursing shortage threatening the nation’s public health.
Occupational Burnout
Lastly, occupational burnout presents a cause for concern regarding the shortage of nursing professionals. The nation faces high patient turnout in health facilities due to affordable insurance policies and an aging population requiring more nurses. However, the number of nurses is less than needed to care for patients, leaving current nurses with immense workloads.
Existing nurses are straining to meet the required service delivery, resulting in stress and burnout. Reith (2018) observed that health facilities have fewer nursing staff due to increased patient population and a shortage of RNs to care for patients. Many RNs quit the profession after a few years due to stress, burnout, and occupational hazards, which have not been addressed by policymakers in the nursing industry.
Besides leaving the occupation, most RNs prefer advancing their education to become nurse practitioners (NP) for better employment opportunities and favorable workplace environments. According to Reith (2018), the number of individuals graduating from nursing schools has not declined in recent years. However, the rate of graduates does not match the job supply and demand, which raises concerns about the whereabouts of the individuals. Although occupational advancements are encouraged, the number of RNs leaving the system exceeds those being absorbed. Combined with the senior RNs leaving their job permanently, the nursing industry will face a shortage that must be urgently addressed.
Conclusion
The shortage of nurses is a growing crisis in the United States. The main reasons for the situation include an aging population and workforce, healthcare policy reforms, occupational burnout, and inadequate nurse educators. America’s population comprises many older adults who demand nursing care. At the same time, the nursing workforce includes more senior nurses who have retired, leaving a significant gap in the profession. The number of retiring nurses, combined with the high demand for registered nurses due to the increased number of outpatients, has created concern for the nurse shortage, which requires more individuals to enroll in nursing schools.
However, nursing colleges have challenges, including a lack of faculty and resources to attract fresh applicants. A shortage of nurse educators means limited trainers and fewer enrollments, which affects the number of nurses entering the industry. Ultimately, registered nurses in the sector face burnout and stress due to high workloads, leading to advancing careers and quitting the profession, causing more shortages. From the discussion, the health sector has much to consider in ensuring the nursing gap is filled in public health.
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